Lauge-Hansen分型推断踝关节骨折成伤机制
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摘要
目的探讨应用医学影像学Lauge-Hansen分型推断踝关节骨折的成伤机制及其在法医学中的应用价值。方法收集2013年1月至2018年5月在浙江省永康市公安局进行法医学鉴定并可获知成伤机制的32例踝关节骨折案例。由3名资深法医分别根据X线、CT等影像学资料进行踝关节骨折LaugeHansen分型。使用SPSS 20.0统计软件对Lauge-Hansen分型结果与通过案情获知的踝关节骨折成伤机制进行Fisher精确检验和Kappa一致性分析。结果 32例中有84.4%(27/32)的踝关节骨折可进行影像学Lauge-Hansen分型。应用Lauge-Hansen分型推断踝关节骨折成伤机制与通过案情获知的成伤机制在结果上一致。结论综合影像学手段进行Lauge-Hansen分型,可较好地应用于部分踝关节骨折成伤机制的推断,为刑事案件现场重建提供客观依据。
Objective To explore the injury mechanism of ankle fracture inferred by the Lauge-Hansen classification with the application of medical imageology and its application value in forensic medicine.Methods A total of 32 ankle fracture cases with known injury mechanism were collected from January2013 to May 2018, which were identified in Yongkang Public Security Bureau, Zhejiang Province. The Lauge-Hansen classification of ankle fracture was performed by three forensic experts based on the data of X-ray and CT image. Fisher's exact test and Kappa consistency analysis were performed by SPSS20.0 statistical software to compare the results of the Lauge-Hansen classification with the injury mechanism of ankle fracture obtained through the criminal evidence. Results In 32 cases, 84.4%(27/32) ankle fractures were classified according to the Lauge-Hansen classification based on medical imaging. The mechanism of ankle fracture identified by the Lauge-Hansen classification was consistent with that obtained through the criminal evidence. Conclusion Based on medical imaging, the Lauge-Hansen classification can be well applied to infer the injury mechanism of ankle fracture in part cases, and provide objective evidence for the crime scene reconstruction of criminal cases.
Objective To explore the injury mechanism of ankle fracture inferred by the Lauge-Hansen classification with the application of medical imageology and its application value in forensic medicine.Methods A total of 32 ankle fracture cases with known injury mechanism were collected from January2013 to May 2018, which were identified in Yongkang Public Security Bureau, Zhejiang Province. The Lauge-Hansen classification of ankle fracture was performed by three forensic experts based on the data of X-ray and CT image. Fisher's exact test and Kappa consistency analysis were performed by SPSS20.0 statistical software to compare the results of the Lauge-Hansen classification with the injury mechanism of ankle fracture obtained through the criminal evidence. Results In 32 cases, 84.4%(27/32) ankle fractures were classified according to the Lauge-Hansen classification based on medical imaging. The mechanism of ankle fracture identified by the Lauge-Hansen classification was consistent with that obtained through the criminal evidence. Conclusion Based on medical imaging, the Lauge-Hansen classification can be well applied to infer the injury mechanism of ankle fracture in part cases, and provide objective evidence for the crime scene reconstruction of criminal cases.
引文
[1] KOVAL K J, LURIE J, ZHOU W, et al. Ankle fractures in the elderly:what you get depends on where you live and who you see[J]. J Orthop Trauma,2005,19(9):635-639.
[2] JENSEN S L, ANDRESEN B K, MENCKE S, et al. Epidemiology of ankle fractures. A prospective population-based study of 212 cases in Aalborg, Denmark[J]. Acta Orthop Scand,1998,69(1):48-50.
[3] RUSSO A, REGINELLI A, ZAPPIA M, et al. Ankle fracture:radiographic approach according to the Lauge-Hansen classification[J]. Musculoskelet Surg,2013,97(S2):S155-S160.
[4]林国钦,杨建惠,陈壮雄. Lauge-Hansen分型在指导踝关节骨折诊断与治疗中的应用[J].临床医学,2017(3):14-15.
[5] OKANOBO H, KHURANA B, SHEEHAN S, et al. Simplified diagnostic algorithm for Lauge-Hansen classification of ankle injuries[J]. Radiographics,2012,32(2):E71-E84.
[6] LAUGE-HANSEN N. Fractures of the ankle.Ⅱ.Combined experimental-surgical and experimentalroentgenologic investigations[J]. Arch Surg, 1950,60(5):957-985.
[7]于涛,俞光荣.踝关节外侧不稳定的生物力学研究进展[J].中国骨与关节损伤杂志,2010,25(1):94-96.
[8] NORDIN M, FRANKEL V H.肌肉骨骼系统基础生物力学[M].邝适存,郭霞,译. 3版.北京:人民卫生出版社,2008:150.
[9] GARDNER M J, DEMETRAKOPOULOS D, BRIGGS S M, et al. The ability of the Lauge-Hansen classification to predict ligament injury and mechanism in ankle fractures:an MRI study[J]. J Orthop Trauma,2006,20(4):267-272.
[10] LAUGE-HANSEN N. Fractures of the ankle.Ⅳ.Clinical use of genetic roentgen diagnosis and genetic reduction[J]. AMA Arch Surg,1952,64(4):488-500.
[11] LAUGE-HANSEN N. Fractures of the ankle.Ⅲ.Genetic roentgenologic diagnosis of fractures of the ankle[J]. Am J Roentgenol Radium Ther Nucl Med,1954,71(3):456-471.
[12] ALEXANDROPOULOS C, TSOURVAKAS S, PAPACHRISTOS J, et al. Ankle fracture classification:an evaluation of three classification systems:LaugeHansen, A.O. and Broos-Bisschop[J]. Acta Orthop Belg,2010,76(4):521-525.
[13] STIELL I. Ottawa ankle rules[J]. Can Fam Physician,1996,42:478-480.
[14]孙建峰,韩斌,邓磊,等.下胫腓联合损伤的诊治[J].中国骨伤,2005,18(4):198-200.
[15] ARIMOTO H K, FORRESTER D M. Classification of ankle fractures:an algorithm[J]. AJR Am J Roentgenol,1980,135(5):1057-1063.
[2] JENSEN S L, ANDRESEN B K, MENCKE S, et al. Epidemiology of ankle fractures. A prospective population-based study of 212 cases in Aalborg, Denmark[J]. Acta Orthop Scand,1998,69(1):48-50.
[3] RUSSO A, REGINELLI A, ZAPPIA M, et al. Ankle fracture:radiographic approach according to the Lauge-Hansen classification[J]. Musculoskelet Surg,2013,97(S2):S155-S160.
[4]林国钦,杨建惠,陈壮雄. Lauge-Hansen分型在指导踝关节骨折诊断与治疗中的应用[J].临床医学,2017(3):14-15.
[5] OKANOBO H, KHURANA B, SHEEHAN S, et al. Simplified diagnostic algorithm for Lauge-Hansen classification of ankle injuries[J]. Radiographics,2012,32(2):E71-E84.
[6] LAUGE-HANSEN N. Fractures of the ankle.Ⅱ.Combined experimental-surgical and experimentalroentgenologic investigations[J]. Arch Surg, 1950,60(5):957-985.
[7]于涛,俞光荣.踝关节外侧不稳定的生物力学研究进展[J].中国骨与关节损伤杂志,2010,25(1):94-96.
[8] NORDIN M, FRANKEL V H.肌肉骨骼系统基础生物力学[M].邝适存,郭霞,译. 3版.北京:人民卫生出版社,2008:150.
[9] GARDNER M J, DEMETRAKOPOULOS D, BRIGGS S M, et al. The ability of the Lauge-Hansen classification to predict ligament injury and mechanism in ankle fractures:an MRI study[J]. J Orthop Trauma,2006,20(4):267-272.
[10] LAUGE-HANSEN N. Fractures of the ankle.Ⅳ.Clinical use of genetic roentgen diagnosis and genetic reduction[J]. AMA Arch Surg,1952,64(4):488-500.
[11] LAUGE-HANSEN N. Fractures of the ankle.Ⅲ.Genetic roentgenologic diagnosis of fractures of the ankle[J]. Am J Roentgenol Radium Ther Nucl Med,1954,71(3):456-471.
[12] ALEXANDROPOULOS C, TSOURVAKAS S, PAPACHRISTOS J, et al. Ankle fracture classification:an evaluation of three classification systems:LaugeHansen, A.O. and Broos-Bisschop[J]. Acta Orthop Belg,2010,76(4):521-525.
[13] STIELL I. Ottawa ankle rules[J]. Can Fam Physician,1996,42:478-480.
[14]孙建峰,韩斌,邓磊,等.下胫腓联合损伤的诊治[J].中国骨伤,2005,18(4):198-200.
[15] ARIMOTO H K, FORRESTER D M. Classification of ankle fractures:an algorithm[J]. AJR Am J Roentgenol,1980,135(5):1057-1063.